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[Therapeutic efficacy of transjugular intrahepatic portosystemic shunt on bleeding gastric varices].
Taehan Kan Hakhoe Chi. 2002 Dec; 8(4):448-57.TK

Abstract

BACKGROUND/AIMS

Gastric variceal bleeding is a severe complication of liver cirrhosis with a high mortality. The purpose of this study was to determine the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with gastric variceal bleedings and predictive factors for survival.

METHODS

We retrospectively analyzed the medical records of 30 consecutive patients with gastric variceal bleedings from January 1998 to March 2001. The causes of cirrhosis were viral hepatitis in 17, alcohol in 12, and biliary cirrhosis in 1. Eighteen patients were in Child-Pugh class B and 9 in class C at the time of TIPS. The median follow-up period was 403 days (3-1,215 days).

RESULTS

TIPS insertion was successful in all 30 patients. The portal pressure gradient (PPG) was significantly reduced from 23+/-8 mmHg to 11+/-5 mmHg (p<0.05). Hepatic encephalopathy, which developed in 3 patients and was aggravated in 1, was improved with medical therapy. Patients with non-alcoholic etiology experienced deterioration of liver function after TIPS. Those with alcoholic etiology did not. The 6-month and 1-year rebleeding rates were 22% and 41%, respectively. 56% of bleeding episodes were associated with stent dysfunction. The degree of PPG reduction and the development of stent dysfunction were independent predictive factors for rebleeding. The 6-month and 1-year survival rates were 83% and 79%. The causes of death were hepatic failure in 3 (37.5%), recurrent variceal bleeding in 3, and others in 2. Child-Pugh class C was the only prognostic factor for survival.

CONCLUSIONS

TIPS was effective in acute hemostasis and the prevention of rebleeding in patients with gastric variceal bleeding. Especially, it can be safely applied to patients with alcoholic etiology and in Child-Pugh class A or B.

Authors+Show Affiliations

Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

kor

PubMed ID

12506249

Citation

Song, Hee Gon, et al. "[Therapeutic Efficacy of Transjugular Intrahepatic Portosystemic Shunt On Bleeding Gastric Varices]." Taehan Kan Hakhoe Chi = the Korean Journal of Hepatology, vol. 8, no. 4, 2002, pp. 448-57.
Song HG, Lee HC, Park YH, et al. [Therapeutic efficacy of transjugular intrahepatic portosystemic shunt on bleeding gastric varices]. Taehan Kan Hakhoe Chi. 2002;8(4):448-57.
Song, H. G., Lee, H. C., Park, Y. H., Jung, S., Chung, Y. H., Lee, Y. S., Yoon, H. K., Sung, K. B., & Suh, D. J. (2002). [Therapeutic efficacy of transjugular intrahepatic portosystemic shunt on bleeding gastric varices]. Taehan Kan Hakhoe Chi = the Korean Journal of Hepatology, 8(4), 448-57.
Song HG, et al. [Therapeutic Efficacy of Transjugular Intrahepatic Portosystemic Shunt On Bleeding Gastric Varices]. Taehan Kan Hakhoe Chi. 2002;8(4):448-57. PubMed PMID: 12506249.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Therapeutic efficacy of transjugular intrahepatic portosystemic shunt on bleeding gastric varices]. AU - Song,Hee Gon, AU - Lee,Han Chu, AU - Park,Young Hwan, AU - Jung,Saera, AU - Chung,Young-Hwa, AU - Lee,Yung Sang, AU - Yoon,Hyun Ki, AU - Sung,Kyu Bo, AU - Suh,Dong Jin, PY - 2002/12/31/pubmed PY - 2004/4/16/medline PY - 2002/12/31/entrez SP - 448 EP - 57 JF - Taehan Kan Hakhoe chi = The Korean journal of hepatology JO - Taehan Kan Hakhoe Chi VL - 8 IS - 4 N2 - BACKGROUND/AIMS: Gastric variceal bleeding is a severe complication of liver cirrhosis with a high mortality. The purpose of this study was to determine the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with gastric variceal bleedings and predictive factors for survival. METHODS: We retrospectively analyzed the medical records of 30 consecutive patients with gastric variceal bleedings from January 1998 to March 2001. The causes of cirrhosis were viral hepatitis in 17, alcohol in 12, and biliary cirrhosis in 1. Eighteen patients were in Child-Pugh class B and 9 in class C at the time of TIPS. The median follow-up period was 403 days (3-1,215 days). RESULTS: TIPS insertion was successful in all 30 patients. The portal pressure gradient (PPG) was significantly reduced from 23+/-8 mmHg to 11+/-5 mmHg (p<0.05). Hepatic encephalopathy, which developed in 3 patients and was aggravated in 1, was improved with medical therapy. Patients with non-alcoholic etiology experienced deterioration of liver function after TIPS. Those with alcoholic etiology did not. The 6-month and 1-year rebleeding rates were 22% and 41%, respectively. 56% of bleeding episodes were associated with stent dysfunction. The degree of PPG reduction and the development of stent dysfunction were independent predictive factors for rebleeding. The 6-month and 1-year survival rates were 83% and 79%. The causes of death were hepatic failure in 3 (37.5%), recurrent variceal bleeding in 3, and others in 2. Child-Pugh class C was the only prognostic factor for survival. CONCLUSIONS: TIPS was effective in acute hemostasis and the prevention of rebleeding in patients with gastric variceal bleeding. Especially, it can be safely applied to patients with alcoholic etiology and in Child-Pugh class A or B. SN - 1226-0479 UR - https://www.unboundmedicine.com/medline/citation/12506249/[Therapeutic_efficacy_of_transjugular_intrahepatic_portosystemic_shunt_on_bleeding_gastric_varices]_ L2 - https://medlineplus.gov/gastrointestinalbleeding.html DB - PRIME DP - Unbound Medicine ER -